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Dr. Gary J. Rosenbaum, M.D., P.A.

Autogenous Reconstruction


Autogenous reconstruction involves the use of a woman's own tissues to make a breast. These types of reconstructions provide a woman with a breast mound when they wake up from surgery unlike an expander that may only slightly be enlarged. Many women and plastic surgeons feel that a more natural breast is achieved using autogenous reconstruction. The most common sites used to make a breast are the lower abdominal region, the back, and the buttock area. The latissimus dorsi flap is one of the earliest reconstructions used following mastectomy. It involves rotating the skin and muscle from the back to the chest. This skin and muscle is tunneled up around the armpit and brought out in the mastectomy area. Often an implant is placed behind the rotated muscle to increase the projection and size of the breast. The TRAM flap (Transverse Rectus Abdominus Muscle) is the most commonly performed autogenous reconstruction. A breast mound is created using the skin, fat, and abdominal muscle to make a breast. The TRAM flap can be tunneled under the upper abdominal area to emerge in the chest. This is referred to as a pedicle TRAM flap. The other method is by reestablishing circulation to the TRAM flap by connecting it to an artery and vein in the chest wall or armpit. This is referred to as a free TRAM flap. The TRAM flap takes about 4-5 hours to perform. Because the muscle is used in the TRAM flap there is a 10-20% chance for developing an abdominal bulge or hernia. Abdominal discomfort has been reported for several months following surgery.

The latest and most advanced technique in autogenous reconstruction is called the DIEP flap (Deep Inferior Epigastria Perforator). It uses the skin and fat of the abdomen but spares the abdominal muscle. The flap requires an experienced surgeon trained in this procedure. The DIEP flap is a free flap that transfers the skin and fat up to the chest where blood flow to this tissue is reestablished. There is virtually no chance for a hernia or abdominal bulge, as the muscle is not sacrificed. This is an important issue for women who are young and active and don't want to alter an active lifestyle. Women are able to recover faster, return to work and activities sooner. There are several studies that report less pain following a DIEP flap as compared to other forms of autogenous reconstruction. The surgery takes about 6 hours to perform. As a breast is comprised of skin and fat the DIEP flap most closely resembles that of a breast. A woman also receives a tummy tuck from this procedure. We are proud to say that Dr. Rosenbaum is one of only a select few in the country trained in the DIEP flap procedure. Dr. Rosenbaum has more experience with DIEP flaps than any other surgeon in Florida.

All forms of autogenous reconstruction take longer than implant surgery. The hospitalization is usually 2-4 days longer. The compromise of circulation to the flap at the time of or immediately after surgery are the main risks to autogenous reconstruction. This circulation loss can manifest itself as a partial loss resulting in what is called fat necrosis or a complete loss of the flap. Patients with a history of smoking are at greater risk for circulation complications following flap procedures. This includes both at the flap as well as the site where the flap is taken from. We recommend to stop smoking for 4 weeks prior to surgery if time permits. Patients who have had tummy tucks or liposuction of the abdomen are not candidates for TRAM or DIEP flaps.

The autogenous reconstructions can only be performed from each site once. Therefore a patient who is at risk of or is considering bilateral mastectomies must factor this in when making the decision for autogenous reconstruction.

Prosthetic Implants

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Dr. Gary J. Rosenbaum, M.D., P.A.
Mount Sinai Hospital Medical Staff Office Pavillion
4302 Alton Rd, Suite 420
Miami Beach, FL 33140
Phone: (305) 538-7726
Facsimile: (305) 538-7725
Email: info@miamidiepflap.com

Please consult your own physician or call Gary J. Rosenbaum,  M.D. for information on treatment options, medical questions or to schedule a private consultation. The content provided on this Internet site is for informational purposes only. In no way shall any of the information, articles, pictures and texts contained herein be regarded as medical advice or recommendations.